Provider Demographics
NPI:1033352398
Name:SHAH, HETAL (MS, CCC-SLP, TSHH)
Entity Type:Individual
Prefix:MS
First Name:HETAL
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:MS, CCC-SLP, TSHH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10440 QUEENS BLVD
Mailing Address - Street 2:18 Y
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-3658
Mailing Address - Country:US
Mailing Address - Phone:646-528-3738
Mailing Address - Fax:
Practice Address - Street 1:10440 QUEENS BLVD
Practice Address - Street 2:18 Y
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-3658
Practice Address - Country:US
Practice Address - Phone:646-528-3738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-15
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012964-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist